By Tom Duncan, M.D.
The Daily Astorian (Ore.), June 2, 2011
Even though Americans spend twice as much on medical care than people in any other industrialized country, our health outcomes are consistently worse. Life expectancy at birth in the United States is rated 36th in the world, lower than Chile or Cuba, and only slightly higher than Portugal or Slovenia. U.S. infant mortality rate falls in 33rd place, well below all of continental Europe, the UK, Ireland, Slovenia, Cyprus and Cuba.
At its May meeting, the Clatsop County Medical Society hosted Dr. Paul Gorman, an internal medicine specialist at Oregon Health & Science University, who spoke about the ongoing health care crisis and the future of American medicine.
Gorman, who formerly practiced internal medicine in Astoria, has become a proponent of the Medicare for All or “single-payer health plan,” which he defines as “publicly financed, privately delivered” medical care. He contrasted the different systems of various industrialized countries with the U.S. system, and pointed out that although U.S. technology and expertise is second to none, our ability to organize and deliver medical care to our people is severely deficient, resulting in major and unnecessary inequalities. The most successful countries have figured out how to combine private and public resources to provide better care for less money.
Gorman points out that although the values of “free choice” and “free markets” are admirable and are touted as the strengths of the American system, most Americans do not have free choice in health care because our employers choose it for us.
If we are unemployed, we may be eligible for a government plan (if we qualify,) or simply go without if we cannot afford the market price of health insurance.
Theoretically, we all have free choice of our doctor, but the reality is that our only practical choice is a doctor who belongs to the same health plan we do, or if we have no health plan, we may simply go to the emergency room in a crisis. We supposedly can choose, together with our doctors, the treatment we think will work best, but in reality, the treatment we receive is that which the insurance company “allows.”
“The medical insurance and pharmaceutical industries have such huge influence in the government – three lobbyists to every congressman in Washington, D.C.,” Gorman says, “that even discussing a reasonable medical care system is difficult in the U.S.”
Many people, including physicians, have been arrested in Washington, D.C., and other American cities for simply trying to speak in support of a single-payer-type system.
Gorman argues that the “market forces” which bring efficiency to other economic endeavors – like selling bananas, for instance – do not usually apply to the provision of medical care. He reminds us that when people are ill, they are not able to hunt for the best bargains, and must rely on experts to help them navigate through the system.
What is more, the government/insurance payment system essentially fixes prices, so there is no price correction – efficient providers who have lower costs are penalized in this system, not rewarded as in a true free market. The basic requirement of a free market, that is – an informed and willing seller, informed and willing buyer – does not apply to the American system, because both the patients and the physicians are effectively excluded from the market by the intermediaries, leading, as expected, to higher costs and poorer performance.
Gorman believes there should be market competition, but there must be an actual market of doctors, patients and hospitals, and not the present market of insurance companies and the government. The proof of this contention is the demonstrable success of health-care provision in Japan, Germany, France, Canada and many other countries, with better outcomes at far less cost than the United States.
There is no lack of resources, and there is plenty of money in the system, Gorman insists. At the present time, the U.S. already spends as much or more public money per capita on health care as any European country – we just have to figure out how to use it more effectively.
Many people would be surprised to know that we already have a cost-effective system in America, called Medicare – a system of medical care that is publicly financed, but privately administered through contractors, and privately delivered by participating physicians. While there are obvious deficiencies, we should build on its strengths, not tear it apart because of its weaknesses, Gorman said.
The Clatsop County Medical Society is an association of physicians, nurse-practitioners and physicians’ assistants engaged in the ongoing assessment and improvement of health care in Clatsop County. It is a component part of the Oregon Medical Association.
